P0941 - Skin Glue for Prevention of Fluid Leaks Following Therapeutic Paracentesis: A Randomized Trial

Award: ACG Governors Award for Excellence in Clinical Research

Award: Presidential Poster Award

Ahmed Alobaidi, MD¹, Syed Rahman, DO¹, Parvez Mantry, MD², Kenneth Raney, MD¹, Brad Pirtle, DO¹, Hassan Allahrakha, DO³, Huda Khan, MD¹, Minyang Cui, MSc^4
1Methodist Dallas Medical Center, Dallas, TX; ²Methodist Liver Institute, Dallas, TX; ³Methodist Dallas, Dallas, TX; ⁴Clinical Research Institute, Dallas, TX

Introduction: Paracentesis is commonly performed for management of ascites. Most frequent complication of paracentesis is fluid leaking from the puncture site. Following Z-track or angular entry techniques during the procedure may reduce leaks, however despite these preventative measures fluid leaks do still occur. Skin glue [2-octyl cyanoacrylate, 2-OCA] has been used successfully for treatment of fluid leaks. Our study looks at the efficacy of skin glue as a preventative measure for fluid leakage after paracentesis.

Methods: IRB approval was obtained. Subjects undergoing therapeutic paracentesis at our institution were consented, enrolled, and randomized to alternating weeks of glue (GG) and no glue (NG) for closure of skin. All procedures were done using standard safe-T-centesis kits. Patients were followed up 48 hours after the procedure to assess for fluid leaks, complications, and reactions from skin glue. Leaks were defined as small if they required 2 or less dressing changes and large or persistent leaks if they required 3 or more dressing changes, placement of ostomy pouch, or skin closure by suture or adhesive.

Results: 232 procedures were performed on 157 patients between February of 2022 and May 2023. 62% of the patients were male and 37.9% female. Mean age was 58.7 years. 120 patients were in GG and 112 in NG. The most common etiologies of ascites were alcoholic liver disease (ALD) (42%), NASH (22.2%), combined ALD and NASH (6.3%), HCV (5.7%), malignancy (5.7%), and cardiac disease (3.8%).



25 total leaks (22.32%) were noted in NG, with 12 (10.71%) being large leaks. 6 total leaks (5%) were noted in GG, with 1 (0.83%) being a large leak.



NG was 5.45 times more likely to leak than GG following therapeutic paracentesis (OR=5.45, CI=2.15-13.89, p< 0.001). NG was 14.28 times more likely than GG to experience a large fluid leak (OR=14.28, CI=1.83-111.73, p=0.001).

Discussion: In this preliminary analysis we found use of skin glue for closure of a skin puncture sites following therapeutic paracentesis significantly reduced the rate of all fluid leaks and large leaks compared to occlusive dressing. We noted the rate of fluid leaks reported here is higher than was previously reported previously by Gottardi et al likely due to use of more sensitive criteria to define a fluid leak, exclusion of diagnostic paracenteses and difference in methodology of data collection. In conclusion we note that use of 2-OCA is effective to prevent fluid leaks following therapeutic paracentesis.



Disclosures:


Ahmed Alobaidi, MD¹, Syed Rahman, DO¹, Parvez Mantry, MD², Kenneth Raney, MD¹, Brad Pirtle, DO¹, Hassan Allahrakha, DO³, Huda Khan, MD¹, Minyang Cui, MSc⁴. P0941 - Skin Glue for Prevention of Fluid Leaks Following Therapeutic Paracentesis: A Randomized Trial, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.